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Distance to Public Sewers Connection necessary: Yee Nod , <br /> Does existing septic !system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed:- <br /> 2. <br /> nstalled:2. WATER SUPPLY <br /> Is water supplied. ba private well: Yes o Is well prgper: <br /> Yes No State def iciency d ��' <br /> E+ <br /> Doe existing or porposed use make this well public water: Yes <br /> NoSample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments a. <br /> 3 . <br /> Licenced scavenger pick--up: Yee No-2:C_' Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: _ _ <br /> 4. FLY, MOSOUTIQ OR VECTOR PO'rEUTIAL � <br /> State possibly: vector potenti{tl necessary control: ,��� - <br /> 5 . JOTT.ET/BATH EACIUIES <br /> No. & location existing: A4tAdditional <br /> facilities needed <br /> 6 . 12REV107S UERAT,192 HISTORX <br /> 7. GEHFEAL SANITA'T'ION <br /> State any problems not previously noted: dt-f <br /> $ . EDFUf ATTQH DRUSITy � <br /> Appx. No. People per .sq. ori. _dC6f441_ =ekei�_Ae.G� — <br />